Anterior cruciate ligament (ACL) rupture is one of the most common sport injuries. The incidence of ACL rupture was estimated to range from 30 to 78 per 100.000 person-years. Several sport contact injuries were reported that highly associated with ACL rupture, such as football (15%) and soccer (5.2%) competition. ACL rupture was also found more common in male than female players. The anatomy of ACL originates from lateral wall of the intercondylar fossa and inserts to the tibial eminence anteriorly. It comprises of two bundles, such as anteromedial and posterolateral bundle. The femoral attachment arises from resident’s ridge to the posterior articular margin of the lateral femoral condyle. The tibial attachment is closely related to the attachment of the lateral meniscus. Return to sport (RTS) remains to be the main goal of ACL reconstruction (ACLR). However, RTS criteria remains debatable due to differences outcome measure. RTS was noted 60-80% in different sports following ACL reconstruction surgery. However, there was several factors that may affect the ACLR surgery. Concomitant ligamentous and meniscus injury may prolong the RTS. Graft choice may also contribute to the process of RTS. Bone-patellar-tendon-bone (BPTB) graft has shown to have early incorporation to the femoral and tibial tunnel due to bone-to-bone healing. Surgical technique also plays role in the early RTS. Single-bundle and double-bundle ACL reconstruction remains debatable in ACLR surgery. However, there was no differences in both surgical techniques in terms of early RTS.

Background. Neglected clubfoot is the most common congenital problem leading to locomotor disability. Eighty percent children with clubfoot deformity are born in developing world and the majority do not have access to appropriate medical care. The severity of clubfoot may be assessed with a variety of methods; i.e Pirani scoring system. This study use Pirani scoring system to evaluate the clinical outcome of neglected clubfoot patients one year after soft tissue release. Method. A study of 17 patients who underwent soft tissue release in Harapan Hospital a year before. We compare Pirani score before and one year after soft tissue release. Other data submitted are age, reason of delayed treatment, term of prosthesis, and complication after surgery. Result. The 17 patients were 10 females and 7 males; the average age was 69.06 ± 49.15 months old. Deformity in left foot was in 13 feet (59.1%) and right foot was in 9 feet (40.9%). The average total Pirani Score before soft tissue release is 5.43 ± 1.03 and one year after soft tissue release is 0.30 ± 0.40, p<0.0001 (p<0.05). This result shows significant improvement one year after soft tissue release. Conclusion. Soft tissue release for neglected clubfoot resulted in significant Pirani score improvement after one year. Latar Belakang. Neglected clubfoot merupakan masalah kongenital yang paling sering menyebabkan disabilitas lokomotor. Tingkat keparahan clubfoot dapat ditentukan dengan beberapa metode, antara lain sistem skor Pirani. Salah satu tata laksana neglected clubfoot adalah soft tissue release. Studi ini mengevaluasi keluaran klinis pasien neglected clubfoot menggunakan sistem skor Pirani satu tahun setelah soft tissue release. Metode. Studi pada 17 pasien yang telah menjalani soft tissue release satu tahun yang lalu. Skor Pirani sebelum dan satu tahun setelah soft tissue release dibandingkan. Data lain meliputi usia, alasan terlambatnya tata laksana, prosthesis yang digunakan, serta komplikasi pasca-operasi. Hasil. Rata-rata pasien berusia 69,06 ± 49,15 bulan, 10 perempuan dan 7 laki-laki. Sejumlah 13 deformitas didapatkan pada kaki kiri (59,1%), 9 deformitas pada kaki kanan (40,9%). Rata-rata skor Pirani sebelum soft tissue release adalah 5,43 ± 1,03, sedangkan rata-rata skor Pirani satu tahun setelah soft tissue release adalah 0,30 ± 0,40. Hasil ini menggambarkan peningkatan signifikan skor Pirani (p < 0,0001). Simpulan. Keluaran klinis pasien neglected clubfoot dinilai menggunakan skor Pirani meningkat signifikan satu tahun setelah soft tissue release.

Preoperative anxiety is frequently correlated with anesthesia procedures, resulting in the anesthesiologist being the most suitable person to decrease the patient's anxiety through effective doctor–patient communication during pre–anesthesia visits. During anxiety, one of the body responses is the release of epinephrine to the blood vessel resulting in increased blood pressure. Objectives: To knew the correlation between pre-anesthesia visit anxiety and blood pressure before anesthesia procedure. Methods: This study used a cross-sectional design that was conducted at Universitas Sumatera Utara General Hospital from September until October 2019. The sample was collected by consecutive sampling techniques, which meet inclusion and exclusion criteria. This study used primary data then was analyzed using Fisher’s Exact Test. Results: From 67 patients going through elective surgery, there are 41 patients (61,2%) with mild anxiety, 17 patients (25,4%) with moderate anxiety, and nine people (13,4%) with severe anxiety. There is no significant correlation (p>0,05) between anxiety with sex, types of anesthesia, PS ASA and heart rate. There is a significant correlation (p<0,05) between anxiety with blood pressure and types of surgery. Conclusion: There is a correlation between anxiety during the pre-anesthesia visit with blood pressure before anesthesia procedures.Keywords:  anesthesia, anxiety, blood pressure, pre-anesthesia visit

Objective-The aim of this study was to determine the comparison of functional clinical outcome of metastase spine disease before and after the action of posterior spinal instrumentation. Material and Methods-This Research using Sixty-one (61) subjects of spine disease metastases were divided into 2 groups, with thirty-six (36) subjects not operating and twenty-five (25) subjects operating spinal posterior instrumentation that met the criteria of Spinal Instability Neoplastic Score (SINS) in the period September 2014 to February 2018 included in the inclusion criteria included in this study where twenty-two (22) total subjects were obtained and data was collected by interviewing techniques assessing clinical outcomes based on VAS, ODI and SF-36.Result-The distribution of 22 Metastase Spine Disease samples with 12 females (54.5%) and 10 females (45.5%) men, with the youngest age of the 41 years research subjects and the oldest age from the 78-year study subjects with mean and standard deviations amounting to 51.7 ± 14.0 years. There were significant differences in results from clinical outcomes before and after the action of posterior spinal instrumentation with a significance value of 0.001 (p <0.05).Conclusion-The functional clinical outcome of metastase spine disease after posterior spinal instrumentation is better than clinical outcome before the action of posterior spinal instrumentation with statistical values (P <0.01), this is in accordance with the initial hypothesis of the study, namely there are differences in functional clinical outcome of spinal metastase patients disease before and after the action of posterior spinal instrumentation.

Introduction Bilateral quadriceps tendon rupture is a rare condition and often associated with underlying medical comorbidities such as chronic renal insufficiency. This case report is aimed to evaluate the surgical outcome using the combination of suture anchor and transosseus repair technique.   Presentation of Case Presenting a 54-year-old male who sustained simultaneous bilateral quadriceps tendon rupture with history of right nephrectomy and chronic kidney disease requiring intermittent hemodialysis. He came with sudden bilateral knee pain, history of falling, and inability to walk since three weeks before admission to the hospital. Tenderness above the superior pole on both patella, accompanied with slight swelling and no active range of motion (ROM) of either knee joint was found on physical examination. Complete rupture of the quadriceps tendon of both knees at their osseus-tendon junction were revealed on magnetic resonance imaging (MRI).   Discussion Recent literatures suggested that transosseus technique offers the safest and more stable tendon reattachment, while suture anchor provides biomechanical superiority. We tried to combine these advantages by incorporating both methods. Progressive active knee motion exercise was performed shortly after using the Kocher slab for 2 weeks.Subsequently, the patient can achieve painless, active extension and active 90°-120° knee flexion 1 month post-operatively.   Conclusion The application of a single suture anchor with transosseus repair in quadriceps tendon rupture led to an optimal outcome, improved stability, and earlier rehabilitation.